Endoscopic Hemostasis Closure Device And Delivery System

ABSTRACT

A device for inserting a medical apparatus into a living body includes a handle and an elongated sheath extending from the handle to a distal end configured for insertion to a target location in the living body in combination with a clasp positioned within a distal portion of the elongated sheath and configured to temporarily attach to an endoscopic device and a spring retention mechanism movable from a first resting configuration maintaining a first closed position of the clasp to a second compressed configuration moving the clasp to an open position. A withdrawal mechanism is movable from a first resting configuration in which the distal end of the elongated sheath extends distally over a distal end of the endoscopic device to a second retracted configuration in which the distal end of the elongated sheath is moved proximally of the distal end of the endoscopic device.

PRIORITY CLAIM

The application claims the priority to the U.S. Provisional ApplicationSer. No. 61/534,623, entitled “Endoscopic Hemostasis Closure Device andDelivery System” filed on Sep. 14, 2011. The specification of theabove-identified application is incorporated herewith by reference.

BACKGROUND

Endoscopic procedures are vital in both the diagnosis and treatment ofvarious medical conditions and diseases. Such procedures include, butare not limited to, surgeries, hemostasis procedures such as clipping,band ligation, injection therapy, thermal electrohemostasis andcombination therapy. In these procedures, an endoscope is inserted to atarget location within a living body and a delivery system including anendoscopic instrument is inserted through a working channel of theendoscope to carry the instrument to the target location. Each deliverysystem is generally adapted to deliver only one type of endoscopicinstrument (e.g., a hemostatic clip) so the number of delivery systemsrequired to perform a variety of procedures is virtually the same as thenumber of endoscopic instruments available to perform this range ofprocedures.

SUMMARY OF THE INVENTION

The present invention relates to a device for inserting a medicalapparatus into a living body which includes a handle and an elongatedsheath extending from the handle to a distal end configured forinsertion to a target location in the living body in combination with aclasp positioned within a distal portion of the elongated sheath andconfigured to temporarily attach to an endoscopic device and a springretention mechanism movable from a first resting configurationmaintaining a first closed position of the clasp to a second compressedconfiguration moving the clasp to an open position. A withdrawalmechanism is movable from a first resting configuration in which thedistal end of the elongated sheath extends distally over a distal end ofthe endoscopic device to a second retracted configuration in which thedistal end of the elongated sheath is moved proximally of the distal endof the endoscopic device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a first perspective view of a device according to a firstexemplary embodiment of the present invention in a first operativeconfiguration;

FIG. 2 shows a magnified view of the device of FIG. 1;

FIG. 3 shows a perspective view of the device of FIG. 1 in a secondoperative configuration;

FIG. 4 shows a perspective view of a clasp according to a firstalternate embodiment of the present invention;

FIG. 5 shows a first perspective view of a hemostasis device accordingto a first exemplary embodiment of the present invention;

FIG. 6 shows a second perspective view of the hemostasis device of FIG.5;

FIG. 7 shows a third perspective view of the hemostasis device of FIG.5;

FIG. 8 shows a first perspective view of a hemostasis device accordingto a second exemplary embodiment of the present invention;

FIG. 9 shows a second perspective view of the hemostasis device of FIG.8;

FIG. 10 shows a third perspective view of the hemostasis device of FIG.8;

FIG. 11 shows a first partial cross-sectional view of a hemostasisdevice according to the present invention in a first operativeconfiguration;

FIG. 12 shows a second partial cross-sectional view of the hemostasisdevice of FIG. 11 in a second operative configuration;

FIG. 13 shows a third partial cross-sectional view of the hemostasisdevice of FIG. 11 in a third operative configuration;

FIG. 14 shows a first perspective view of a clasp according to a secondalternate embodiment of the present invention;

FIG. 15 shows a second perspective view of a clasp according to a secondalternate embodiment of the present invention;

FIG. 16 shows a first perspective view of a clasp according to a thirdalternate embodiment of the present invention; and

FIG. 17 shows a second perspective view of a clasp according to a thirdalternate embodiment of the present invention.

DETAILED DESCRIPTION

The present invention may be further understood with reference to thefollowing description and the appended drawings, wherein like elementsare referred to with the same reference numerals. The present inventionrelates to devices for performing a variety of endoscopic proceduresincluding, but not limited to, clipping, band ligation, injectiontherapy, thermal electrohemostasis, combination therapy needle, biopsiesand fine-needle aspiration. The exemplary delivery system according tothe present invention is formed as an elongated device having a handleat a proximal end and a clasp at a distal end configured to house atleast one custom endoscopic device therein. The clasp is controlled by aspring mechanism to permit a physician or other user to actuate theclasp to release the endoscopic device therefrom when desired, as willbe described in greater detail below. The endoscopic device may be ahemostasis device configured to move from a compressed configurationwithin the clasp to a deployed expanded configuration to stop a flow ofblood or other fluid in the target location, as will also be describedin greater detail hereinafter. It should be noted that the terms“proximal” and “distal,” as used herein, are intended to refer to adirect toward (proximal) and away from (distal) a user of the device.

As shown in FIGS. 1-2, a device 100 according to a first exemplaryembodiment of the invention extends longitudinally from a proximal end102 comprising a handle 104 to a distal end 106 comprising an elongateflexible sheath 108. As would be understood by those skilled in the art,the device 100 may be formed of one of any of a variety of biocompatiblematerials including, for example, a plastic, a bio-absorbable material,coated metals and Nitinol. The handle 104 comprises a finger loop 110and a spool 112 configured to aid in gripping and actuation of thedevice 100. A spring retention mechanism 114 is positioned distally ofthe handle 104 and may comprise a coil 116 wound over an elongatedbarrel 118. It is noted that although the present embodiment has beendescribed with a coil 116, any spring may also be employed hereinwithout deviating from the scope of the invention. In a firstconfiguration, the coil 116 is compressed between the handle 104 and aradial abutment 120. An elongated cylinder 122 extends from the radialabutment 120 and may comprise a tapered portion 124 tapering down to asmaller diameter of an elongated portion 107 the diameter of which ismade small enough to permit insertion thereof through the workingchannel of an endoscope while still housing a selected endoscopic devicetherewithin, as will be discussed in greater detail below. In anotherembodiment of the invention, the coil 116 may be omitted from the device100.

The elongated portion 107 is fitted with a removable safety clip 126formed as a jacket that may include first and second arms 128, 130biased toward each other and enclosing an elongated groove 132. In anoperative configuration, a physician or other used slides the safetyclip 126 over the elongated portion 107 to temporarily separate thefirst and second arms 128, 130 from one another inserting the elongatedportion 107 into the groove 132, as shown in FIG. 1. An accordionedsheath withdrawal mechanism 134 may be positioned distally of the safetyclip 126 with a distal end of the withdrawal mechanism 134 connecting toa proximal end of an elongated sheath 108 via a coupler 136. Thewithdrawal mechanism 134 is prevented from moving proximally over theelongated portion 107 by engagement with the safety clip 126. In anexemplary embodiment, a length of the safety clip 126 is selected to besubstantially equivalent to the combined length of a clasp 144 within adistal portion of the sheath 108 and an endoscopic device attached tothe clasp 144, as will be discussed below. Specifically, the safety clip126 is preferably dimensioned so that upon its removal from the device100, proximal retraction of the elongated sheath 108 over the elongatedportion 107 is permitted by a distance sufficient to expose the clasp144 and an endoscopic device attached thereto from the distal end of thesheath 108. Specifically, an outer diameter of the elongated portion 107is smaller than an inner diameter of the elongated sheath to permit theelongated sheath 108 to slide thereover when retracted. As shown in FIG.2, in the resting configuration, the distal end 106 of the elongatedsheath 108 extends distally over a distal end 216 of the first leg 204of a hemostasis device 200 attached to the clasp 144, as will bedescribed in greater detail later. The resting configuration istherefore suited to use during insertion of the elongated sheath 108 toa target location in the body and withdrawal of the device therefrom.

A lumen 138 extends through the length of the elongated sheath 108 withan elongated flexible clevis 140 extending therethrough. Specifically, aproximal portion (not shown) of the clevis 140 extending through thesheath 108 may be formed as a rod or wire. A proximal end (not shown) ofthe clevis 140 is operably connected to the spring retention mechanism114 so that actuation of the spring retention mechanism 114 moves theclevis 140 within the controls operation of the clasp 144. Specifically,a distal end 142 of the clevis 140 is connected to the clasp 144 via apivoting attachment comprising a pivot pin 146 inserted through a pivothole 148 extending transversely through the first and second arms 150,152 of the clasp 144. As those skilled in the art will understand, thepivoting attachment permits the first and second arms 150, 152 to movewithin a wide range of angles relative to one another. In an exemplaryembodiment, the first and second arms 150, 152 may move up to 120°relative to one another although any other range of movement may beemployed without deviating from the scope of the invention. Each of thearms 150, 152 is formed with a curved cross-sectional shape so that whenthe first and second arms 150, 152 are brought into a closedconfiguration (not shown), a hollow cavity 154 is defined therebetween.Specifically, each of the arms 150, 152 may be substantially concave todefine the cavity 154 therebetween. Furthermore, although asubstantially semi-circular shape is shown for each of the arms 150,152, any other shape may be used without deviating from the spirit andscope of the invention. The curved shape of each of the arms 150, 152also permits insertion of the clasp 144 through the hollow channel 138while maximizing the size of the hollow cavity 154. However, as thoseskilled in the art will understand and as will be described in greaterdetail below, the cavity 154 may be made in any shape desired to grip aconnecting part of an endoscopic device to be deployed thereby. Forexample, the cavity 154 may be configured to house one or morehemostasis devices 200, 300.

Each of the first and second arms 150, 152 comprises a slotted opening154 extending therethrough configured to receive a tab 208 formed on thehemostasis device 200, as will be described in greater detail later. Itis noted that although the present embodiment is depicted with a singleopening 156 formed on each of the first and second arms 150, 152, theclasp 144 may alternately be formed with any number of openings on oneor both of the first and second arms 150, 152 without deviating from thescope of the invention. The opening 156 may be formed of any shapewithout deviating from the scope of the invention (e.g., slotted, etc.).The number and position of the openings may be selected to conform tothe tabs 208 provided on the hemostasis device 200.

FIG. 4 depicts a clasp 144′ according to another embodiment of theinvention. The clasp 144′ is formed substantially similarly to the clasp144 but does not comprise openings 156 extending through the first andsecond arms 150′, 152′. Rather, the first and second arms 150′, 152′ areprovided with tabs 156′ configured to receive openings 308 formed on ahemostasis device 300. Each of the clasps 144, 144′ comprises a pullwire attachment 158 provided on a proximal end of one or both of thefirst and second arms 150, 152 and 150′, 152′, respectively. The pullwire attachment 158 is connected to a wire (not shown) extending throughthe elongated sheath 108 to the spring mechanism 114 so that actuationof the spring mechanism causes the wire (not shown) to move the clasp144, 144′ to an open configuration. Specifically, actuation of the wire(not shown) permits the first arm 150, 150′ to move pivotally away fromthe second arm 152, 152′ about a pivot axis defined by the pivot pin146. A user may actuate the spring mechanism 114 any plurality of timesto move the clasp 144, 144′ between the open and closed configurations.

In another embodiment of the invention (not shown), the clasp 144, 144′is provided with a snap and/or cartridge design to permit loading of anycustom device thereonto. Specifically, while the present invention hasbeen described with respect to a particular hemostasis device 200, thoseskilled in the art will understand that a variety of differentendoscopic devices may be fitted to the clasp 144, 144′ withoutdeviating from the scope of the invention. The clasp 144, 144′ maytherefore be provided with any type of retention mechanism suitable toengage a desired device.

FIG. 5 depicts a first exemplary hemostasis closure device 200 accordingto the invention. The device 200 comprises a base portion 202 havingfirst and second legs 204, 206 extending distally therefrom. In a firstinsertion configuration as shown in FIG. 11, the first and second legs204, 206 extend substantially parallel to the base portion 202.Specifically, the first leg 204 is positioned to extend distally fromthe base portion 202 while the second leg 206 is positioned to extendproximally from the base portion 202. In an alternate embodiment (notshown), both of the first and second legs 204, 206 may be positioned toface either proximally or distally of the base portion 202.

The first and second legs 204, 206 are held in this insertionconfiguration within the elongated sheath 108 by frictional engagementwith inner walls thereof as well as with inner walls of the first andsecond arms 150, 152 of the clasp 144. In another embodiment, the firstand second legs 204, 206 may be held in the insertion configuration viaa capsule (not shown) positioned therearound, as those skilled in theart will understand. The base portion 202 comprises at least one tab 208extending therefrom configured to mate with the slotted opening 156 ofthe clasp 144, as described in greater detail earlier. The position ofeach of the one or more tabs 208 corresponds to a position of acorresponding one of the slotted openings 156. When inserted into theslotted openings 156, the tabs 208 hold the closure device 200 againstthe clasp 144 and aid in deploying and positioning the closure device200 within the body, as will be described in greater detail later on.The first and second legs 204, 206 are connected to the base portion 202via a joint 210 which may be a bolt, interference fit, snap tit or otherattachment mechanism known in the art. It is further noted that althoughtwo legs 204, 206 are shown in the current embodiment to allow for asmaller profile during deployment of the closure device 200 in the body,any number of legs may be employed without deviating from the spirit andscope of the present invention.

Each of the first and second legs 204, 206 also comprises one or morecutouts 212 each defining a hook 214 extending proximally therefrom. Inthis embodiment, the cutouts 212 are substantially rectangular in shapeand are formed via first, second and third cuts extending through thefirst and second legs 204, 206. It is noted however that the cutouts 212may take any shape without deviating from the spirit and scope of theinvention. Each hook portion 214 extends proximally away from a planehousing the corresponding cutout 212 angled at approximately 45°relative to the plane to form the hook portions 214 as proximallyextending barbs. However, as would be understood by those skilled in theart, any other angle may be used without deviating from the scope of thepresent invention so long as the hook portions 214 are angled to operateas barbs to engage target tissue. Specifically, each hook 214 is biasedto extend away from the plane housing the corresponding cutout 212 in anon-compressed configuration. When housed within the elongated sheath108, however, restrictive forces applied by the inner wall of theelongated sheath 108 may move the hooks 214 to a compressedconfiguration in which the hooks 214 lie substantially flush with theplanes of the corresponding cutouts 212, as shown in FIG. 11. It isfurther noted that although the present embodiment is depicted with twohooks 214 on each of the first and second legs 204, 206 any number ofhooks 214 may be employed without deviating from the scope of theinvention. Furthermore, the hooks 214 may alternatively be configured toextend distally from the first and second legs 204, 206. In an exemplaryembodiment, the hooks 214 may be formed with varying sizes to aid incapturing tissue, as those skilled in the art will understand. A distalend of each of the first and second legs 204, 206 may come to asharpened point 216 configured to aid in piercing and traversing pasttissue, as those skilled in the art will understand.

As shown in FIGS. 5-7, the first and second legs 204, 206 of the device200 according to this embodiment are substantially planar. In anotherembodiment, as shown in FIGS. 8-10, the device 300 include first andsecond legs 304, 306 with a curved cross-sectional shape configured toaid in tissue retention, as those skilled in the art will understand. Itis noted that although the legs 304, 306 are depicted as having aparticular radius of curvature, any other radius of curvature may beemployed without deviating from the scope of the invention. An exemplaryradius of curvature of the first and second legs 304, 306 is selected inaccordance with size limitations of the clasp 144′ and the elongatedsheath 108 as well as the requirements of a particular procedure to beperformed in a living body, as those skilled in the art will understand.The closure device 300 is otherwise formed substantially similarly tothe closure device 200, with first and second legs 304, 306 extendingdistally from a base portion 302. However, where the base portion 202was connected to the first and second legs 204, 206 via a joint 210, thebase portion 302 is formed integrally with the first and second legs304, 306. Specifically, the base portion 302 is a hollow substantiallycylindrical element having at least one opening 308 extendingtherethrough configured and dimensioned to receive the tab 156′ of theclasp 144′ of FIG. 4. The first and second legs 304, 306 also compriseopenings 312 defining hooks 314 extending thereoutof at any selectedangle as described above. Each of the first and second legs 304, 306 mayterminate at a sharpened distal point 316. Furthermore, the legs 304,306 may be provided with predetermined respective lengths, widths andthicknesses to affect performance thereof once implanted, as thoseskilled in the art will understand.

FIGS. 14-15 depict a hemostasis closure device 400 according to anotherembodiment of the invention. The device 400 is substantially similar tothe device 300 of FIGS. 8-10 but is formed with a round-wire design.Specifically, the device 400 comprises a base portion 402 having firstand second legs 404, 406 extending distally therefrom. The first andsecond legs 404, 406 may be formed of a solid wire or, in anotherembodiment, may be an extension of the wire (not shown) extendingthrough the elongated sheath 108 to the handle 104, as discussed ingreater detail earlier. The round wire design of the closure device 400permits a wider range of curvature of the first and second legs 404, 406while also preventing trauma to adjacent portions of tissue. In aninsertion configuration (not shown), the first and second legs 404, 406may assume a position substantially similar to that of closure devices200, 300 as described in greater detail earlier. In an expandedconfiguration, each of the first and second legs 404, 406 extends at anangle relative to a longitudinal axis of the base portion 402. Each ofthe legs 404, 406 comprises a plurality of elongated portions 408, 410,412, 414, 416 connected to one another. As would be understood by thoseskilled in the art, any number of elongated portions may be employedwithout deviating from the scope of the invention. Furthermore, each ofthe elongated portions 408, 410, 412, 414, 416 may be formed of anylength suitable for a desired procedure. As those skilled in the artwill understand, a longer length may be used if a larger radius ofcurvature is to be applied to a particular portion of the legs 404, 406and a shorter length may be used if a smaller radius of curvature is tobe applied. Accordingly, the lengths of each of the elongated portions408, 410, 412, 414, 416 may be selected to permit the legs 404, 406 toconform to the anatomy of a target portion of tissue. Furthermore, ajoint between each of the elongated portions 408, 410, 412, 414, 416 mayfunction as a pivot point, permitting angling of each of the elongatedportions 408, 410, 412, 414, 416 relative to one another at any angle.In one embodiment, each of the elongated portion 408, 410, 412, 414, 416may be biased to have a predetermined radius of curvature and each ofthe joints between adjacent ones of the elongated portions 408, 410,412, 414, 416 may be biased to permit adjacent ones of the elongatedportions to be angled at a desired angle. For example, as shown in FIG.14, the elongated portion 414 may be biased to an obtuse angle relativeto the elongated portion 412. The first and second legs 404, 406 mayeach be formed with different numbers and lengths of elongated portionswithout deviating from the scope of the invention. As shown in FIG. 15,the second leg 406 may comprise additional elongated portions 418, 420having a length and curvature suited to the requirements of a particularprocedure.

As shown in FIGS. 16-17, a closure device 500 according to anotherexemplary embodiment of the invention is substantially similar to thedevice 300 but is formed according to a round wire design. Specifically,the device 500 comprises first and second legs 504, 506 extending from abase portion 502. The legs 504, 506 are formed of a round wire having,for example, a substantially cylindrical shape. An overmold 508 providedover the first and second legs 504, 506 is formed of a plastic or othersuitable material and includes barbs 514 extending therefrom. The barbs514 may be formed substantially similar to the barbs 314 of the closuredevice 300. A curvature of the first and second legs 504, 506 issubstantially similar to that of the closure device 300. The closuredevices 200, 300, 400, 500 may be provided with first and second legs ofdifferent lengths selected to conform to the requirements of particularprocedures. A position and number of the hooks and/or barbs may also bevaried without deviating from the scope of the invention.

FIGS. 11-13 depict an exemplary method of operating the device 100according to the present invention. The device 100 is initially loadedwithin the sheath 108 with the first leg 204 extending distally from theclasp 144 toward the distal end 106 of the elongated sheath 108 whilethe second leg 206 extends proximally from the clasp 144. In thisposition, the elongated sheath 108 is guided to a target position withina living body, for example, by passing the sheath 108 through theworking channel of an endoscope. In the insertion configuration, theclasp 144 is maintained in the closed position via compressive forceapplied by the spring retention mechanism 114. The distal end 106 of thesheath 108 is extended distally from the end of the endoscope and passedthrough a wound or surgical opening to be closed. At this point, theuser removes the safety clip 126 from the device 100. A physician orother user then applies a proximally directed force to the withdrawalmechanism 134 to move the elongated sheath 108 proximally relative tothe clasp 144 and closure device 200. As the elongated sheath 108 movesproximally and the first leg 204 extends distally from the sheath 108,the compressive force applied to the first leg 204 by the sheath 108 isremoved, allowing the first leg 204 to rotate under its natural biasuntil it extends transverse to a longitudinal axis of the elongatedsheath 108 (in this embodiment, substantially perpendicularly to theaxis), as shown in FIG. 12. In an alternate embodiment, each of thefirst and second legs 204, 206 may be biased to extend away from thecompressed insertion configuration by an angle greater than 90° so that,upon deployment, the first and second legs 204, 206 can pinch and/orapply a greater holding force to the target tissue, as those skilled inthe art will understand. This rotation causes the first leg 104 and thehooks 214 to engage the tissue on one side of the opening to be closedwith the angulation of the hooks 214 drawing the tissue toward the clasp144. The exemplary first and second legs 204, 206 according to theinvention may be deployed in any other way without deviating from thescope of the invention as long as the first and second legs 204, 206maintain a low profile during insertion and a extend to a high profilewhen deployed. For example, in one embodiment (not shown), the first andsecond legs 204, 206 may be folded in on themselves during insertion andmay unfold upon proximal retraction of the elongated sheath 108.Specifically, the first and second legs 204, 206 may each be formed withone or more fold lines defining folding positions thereof when receivedwithin the elongated sheath 108. In another embodiment, the first andsecond legs 204, 206 may be wrapped (e.g., helically, etc.) about oneanother or about the elongated sheath 108 and may unfurl upondeployment.

The distal end 106 of the sheath 108 is then angled relative to theopening and the sheath 108 is moved further through the opening untilthe outer end of the second leg 206 within the sheath 108 extendsthrough the opening. At this point, the elongated sheath 108 iswithdrawn further proximally to expose the second leg 206 which nowrotates under its natural bias to extend transverse to the longitudinalaxis of the elongated sheath 108, as shown in FIG. 13. The user thendraws the sheath 108 to fully expose the clevis 140 proximally to bringthe hooks 214 of the second arm 206 into engagement with the tissue,drawing the opening closed around the clasp 144 closing the opening.Further proximal retraction of the elongated sheath via the withdrawalmechanism 134 exposes the clasp 144 and the tab 208. Specifically, thesafety clip 126 is configured and dimensioned so that when thewithdrawal mechanism 134 is moved to a proximal-most position, the clasp144 is positioned distally of the distal end 106 of the elongated sheath108.

The elongated cylinder 122 is then moved proximally to longitudinallycompress the spring mechanism 114, the compression causing an actuationof the wire (not shown) extending from a proximal end of the device 100,through the elongated sheath 108 to the pull wire attachment 158 of theclasp 144. This actuation causes the wire (not shown) to pull proximallyon a tang of the clasp 144 and move the clasp to the open configurationof FIG. 3 with the first arm 150 pivoted away from the second arm 152about the pivot pin 146. This movement causes the tabs 208 of theclosure device 200 to disengage from the slotted openings 156,separating the closure device 200 from the device 100. The clevis 140 isthen withdrawn proximally to draw the clasp 144 into the sheath 108 andthe device 100 is then withdrawn from the body. The elongated sheath 108may be moved distally to cover the clasp 144 and the entire device 100may be removed from the body. In another embodiment of the invention,one or more additional closure devices 200 may be inserted to the targetregion in accordance with the requirements of a particular procedure, asthose skilled in the art will understand. For example, the device 100may be withdrawn from the body and a second closure device 200 may becoupled to the clasp 144 and loaded into the sheath 108. The user maythen apply this second closure in the same manner indicated above.

The exemplary device according to the present invention may beparticularly useful in stopping bleeding within the mucosal and serosallayers of the stomach where clipping via presently available systems andmethods has often been ineffective in stopping blood from exiting theserosal side. Specifically, the endoscope is inserted into the stomachand the sheath 108 is extended through an opening out of the stomach sothat the hooks 214 of the first and second legs 204, 206 engage thesubmucosal layer as described above to close and seal the opening in thestomach wall. Furthermore, the device may be deployed from one of withinand outside a body organ so position the closure devices one of withinand outside of the organ, respectively.

It will be understood by those of skill in the art that individualfeatures of the embodiments described above may be omitted and orcombined to form alternate embodiments. The components of the exemplarysystem according to the invention may be formed of one or more ofNitinol, stainless steel, elgiloy, polymers, biocompatible materials andcombination of the above. Furthermore, it will be understood by thoseskilled in the art that various modification can be made in thestructure and the methodology of the present invention, withoutdeparting from the spirit or scope of the invention. For example, theexemplary closure device 200 according to the invention may be guidedand actuated by a device other than the clasp 144. In one suchembodiment (not shown), the closure device 200 may be attached to a wire(not shown) having a frangible connection configured to fracture uponactuation by a user, as described in greater detail earlier. In such anembodiment, the closure device 200 may omit the tabs 208. Rather, theclosure device 200 may be attached to the wire (not shown) by one of anadhesive, weld, hook, interference fit, etc., as those skilled in theart will understand.

Thus, it is intended that the present invention cover the modificationsand variations of this invention provided that they come within thescope of the appended claims and their equivalents.

1-25. (canceled)
 26. A tissue clipping system, comprising: an elongatedsheath extending from a proximal end to a distal end configured forinsertion to a target location in the living body; a tissue clipcomprising first and second legs extending distally from a base portion,each of the first and second legs including first and second elongatedportions coupled to one another via a first hinge to permit angling ofthe first and second elongated portions relative to one another; and aclasp positioned within a distal portion of the elongated sheath andconfigured to releasably grasp the base portion of the tissue clip, theclasp comprising first and second arms configured to be movable from aclosed configuration to an open configuration.
 27. The system of claim26, wherein the first and second elongated portions are coupled to oneanother by a pivot joint permitting angling of each of the elongatedportions at any angle.
 28. The system of claim 26, wherein the tissueclip is biased toward an open configuration in which each of the firstand second legs extends transverse to a longitudinal axis of the baseportion, the tissue clip being held in a closed configuration whenlocated within the sheath by a compressive force applied thereto by thesheath.
 29. The system of claim 26, wherein at least one of the firstand second elongated portions is biased toward a resting state in whichit curves about a predetermined radius of curvature.
 30. The system ofclaim 26, wherein the first leg includes a third elongated portioncoupled to the second elongated portion thereof via a second hinge. 31.The system of claim 27, wherein, when in the closed configuration whenreceived within the sheath, the first leg extends distally from the baseportion and the second leg extends proximally from the base portion. 32.The system of claim 27, wherein, in the closed configuration, both ofthe first and second legs of the tissue clip extend one of proximallyand distally from the base portion.
 33. The system of claim 27, whereinthe base portion of the tissue clip comprises a tab configured to engagea corresponding slot in the clasp to permit engagement therewith,disengagement of the tab from the slot deploying the tissue clip in theliving body.
 34. The system of claim 26, wherein first and secondelongated portions have different lengths to permit first and secondlegs to conform to the anatomy of a target portion of tissue.
 35. Thesystem of claim 26, wherein the first and second elongated portions ofeach of the first and second legs are formed from a length of wire. 36.A system for causing hemostasis in a living body, comprising: a tissueclip having first and second legs extending from a base portion, each ofthe first and second legs including first and second elongated portionscoupled to one another via a hinge, the first and second portionsconfigured to conform to the anatomy of a target portion of tissue; anda clasp comprising first and second arms movable between a closedconfiguration in which the first and second arms are positioned adjacentone another to grasp the base portion and an open configuration in whichthe first and second arms are spread apart from one another to releasethe base portion, at least one of the first and second arms comprising aslotted opening configured to receive a first tab formed on the baseportion when in the closed configuration.
 37. The system of claim 36,wherein the first and second arms comprise substantially concave shapessuch that, when the clasp is in the closed configuration, a cavity isdefined between the first and second arms corresponding in size andshape to a portion of the base portion to be gripped thereby.
 38. Thesystem of claim 36, further comprising a sheath sized and shaped forinsertion through a working channel of an endoscope, wherein the tissueclip is biased toward an open configuration in which each of the firstand second legs extends transverse to a longitudinal axis of the baseportion when extended distally from the sheath and is held in a closedconfiguration when located within the sheath by a compressive forceapplied thereto by the sheath.
 39. The system of claim 36, wherein atleast one of the first and second elongated portions is biased toward aresting state in which it curves about a predetermined radius ofcurvature.
 40. The system of claim 38, wherein, when in the closedconfiguration when received within the sheath, the first leg extendsdistally from the base portion and the second leg extends proximallyfrom the base portion.
 41. The system of claim 38, wherein, in theclosed configuration, both of the first and second legs of the tissueclip extend one of proximally and distally from the base portion. 42.The system of claim 36, wherein the first leg includes a third elongatedportion coupled to the second elongated portion thereof via a secondhinge.
 43. The system of claim 36, wherein the first and secondelongated portions are coupled to one another by a pivot joint.